f all athletic knee injuries, an anterior cruciate ligament (ACL) rupture is the most devastating, resulting in the greatest time lost from sport. 8 The ACL plays a vital role in the normal function and stability of the knee, and individuals wishing to return to sport after rupture are encouraged to consider reconstructive surgery. 29 Those that opt Nonexperimental methodological study.To determine the interrater and intrarater reliability and validity of using observational risk-screening guidelines to evaluate dynamic knee valgus.A deficiency in the neuromuscular control of the hip has been identified as a key risk factor for noncontact anterior cruciate ligament (ACL) injury in postpubescent females. This deficiency can manifest itself as a valgus knee alignment during tasks involving hip and knee flexion. There are currently no scientifically tested methods to screen for dynamic knee valgus in the clinic or on the field.Three physiotherapists used observational risk-screening guidelines to rate 40 adolescent female soccer players according to their risk of ACL injury. The rating was based on the amount of dynamic knee valgus observed on a drop-jump landing. Ratings were evaluated for intrarater and interrater agreement using kappa coefficients. Sensitivity and specificity of ratings were evaluated by comparing observational ratings, with measurements obtained using 3-dimensional (3-D) motion analysis.Kappa coefficients for intrarater and interrater agreement ranged from 0.75 to 0.85, indicating that ratings were reasonably consistent over time and between physiotherapists. Sensitivity values were inadequate, ranging from 67% to 87%. This indicated that raters failed to detect up to a third of "truly high-risk" individuals. Specificity values ranged from 60% to 72%, which was considered adequate for the purposes of the screening.Observational risk screening is a practical and cost-effective method of screening for ACL injury risk. Rater agreement and specificity were acceptable for this method, but sensitivity was not. To detect a greater proportion of individuals at risk of ACL injury, coaches and clinicians should ensure that they include additional tests for other high-risk characteristics in their screening protocols.Prognosis, level 4.

There is a need to investigate the effect of specific movement strategies in reducing biomechanical risk factors for anterior cruciate ligament injury in young female athletes. The purpose of this study was (a) to determine the feasibility of implementing a novel movement strategy (Core-PAC) into a team warm-up before soccer training based on subject compliance and integration of the Core-PAC into the warm-up and (b) to determine whether the Core-PAC would improve peak knee flexion angles and peak abduction moments at the knee during a side cut (SC) and an unanticipated side cut (USC) before kicking a soccer ball, and a side hop (SH) task after immediate instruction and after a 4-week training program. A convenience sample of ten 14- to 16-year-old female soccer players were instructed in the Core-PAC immediately after baseline testing and during a training program consisting of a 20-minute warm-up, 2 times per week. The Core-PAC was understood and accepted by the subjects and incorporated into their warm-up activities with good compliance. After the immediate instruction, there were significant increases in peak knee flexion angles of a mean 6.4° during the SC (p = 0.001), 3.5° during the USC (p = 0.007), and 5.8° during the SH (p < 0.001) tasks. Peak knee abduction moments decreased by a mean of 0.25 N·m·kg(-1) during the SC (p < 0.03), 0.17 N·m·kg(-1) during the USC (p = 0.05), and 0.27 N·m·kg(-1) during the SH (p = 0.04) tasks. After the 4-week training program, some individuals showed improvement. The results of this study suggest that the Core-PAC may be 1 method of modifying high-risk movements for ACL injury such as side cutting and single-leg landing.

Objective-To determine the effect of a novel movement strategy incorporated within a soccer warm-up on biomechanical risk factors for ACL injury during three sport-specific movement tasks.Design-Single-blind, randomized controlled clinical trial. Setting-Laboratory setting.Participants-20 top-tier female teenage soccer players.Interventions-Subjects were randomized to the Core Position and Control movement strategy (Core-PAC) warm-up or standard warm-up which took place prior to their regular soccer practice CIHR Author ManuscriptCIHR Author Manuscript CIHR Author Manuscript over a 6-week period. The Core-PAC focuses on getting the centre of mass closer to the plant foot or base of support.Main Outcome Measures-Peak knee flexion angle and abduction moments during a side-hop (SH), side-cut (SC) and unanticipated side-cut (USC) task after the 6-weeks with (intervention group only) and without a reminder to use the Core-PAC strategy.Results-The Core-PAC group increased peak flexion angles during the SH task (Mean difference = 6.2°, 95% CI: 1.9-10.5°, effect size = 1.01, P = 0.034) after the 6-week warm-up program without a reminder. In addition, the Core-PAC group demonstrated increased knee flexion angles for the side-cut (Mean difference = 8.5°, 95% CI: 4.8-12.2°, ES = 2.02, P = 0.001) and side-hop (Mean difference = 10.0°, 95% CI: 5.7-14.3°, ES = 1.66, P = 0.001) task after a reminder. No changes in abduction moments were found.Conclusions-The results of this study suggest that the Core-PAC may be one method of modifying high-risk soccer-specific movements and can be implemented within a practical, teambased soccer warm-up. The results should be interpreted with caution due to the small sample size.

BackgroundEpidemiological data and logistical details are crucial pieces of information for organisers of medical care at mass sporting events.ObjectiveTo outline the medical facilities at the 2010 Winter Olympic Games and to report the epidemiology of medical encounters.DesignProspective descriptive study.SettingNine competition venues, six non-competition venues and two Polyclinics (Vancouver and Whistler). Medical services were available at all venues. The Polyclinics housed an inter-disciplinary team of health-care professionals. Imaging modalities (including CT and MRI) were on-site at the Polyclinics.Participants2567 athletes, 82 National Olympic Committees, an estimated 4000 Officials, 25 000 Workforce/Volunteers, 10 000 Performers and 10 000 Media. Medical Services included 1560 volunteers and 19 full-time staff.AssessmentMedical encounters were entered into a Medical Encounter Database (ATOS Origin). Games-Time reporting period was February 4th to 28th, inclusive. Computers were located at each Venue.Main outcome measureMedical encounters.ResultsThere were 9038 medical encounters (8198 accredited; 840 spectator). The busiest venues were the Whistler Polyclinic (n=3124) and Vancouver Polyclinic (n=2930). Of the competition venues, the busiest were Whistler Sliding Centre (bobsleigh/luge/skeleton), Canada Hockey Place and Pacific Coliseum (figure skating and short track speed skating). Venues with the greatest number of spectator medical encounters were Canada Hockey Place (n=186), B.C. Place Stadium (Opening/Closing Ceremonies) (n=128) and UBC Sports Centre (hockey) (n=90). Sports with the highest and lowest athlete medical encounters were Alpine Skiing and Nordic Combined, respectively. The majority of encounters were musculoskeletal (MSK) (n=29%). There were 131 ground ambulance transfers and seven air ambulance extractions/transfers resulting in 14 hospital admissions and 43 outpatient visits.ConclusionThe majority of medical encounters were seen at the Polyclinics. Although most were MSK, there was a high demand for other disciplines such as Dental and Imaging. Multi-disciplinary Polyclinics equipped with primary and ancillary services are essential at future Games.

Background The medical care programme during Paralympic Winter Games should refl ect the particular needs and necessities of Paralympic athletes and their support staff. Objective To characterise in detail the medical encounters at the 2010 Vancouver Paralympic Winter Games in order to improve knowledge or injury and illness patterns for medical providers at future adaptive sports events. Design Prospective (sports) injury epidemiological study. Setting The data collection took place during the Vancouver 2010 Paralympic Winter Games. Participants Data are reported on all persons involved in the Vancouver 2010 Paralympic Winter Games that consulted VANOC Medical Services, with particular emphasis on athlete records (n=502 participating athletes).Interventions Systematic records were held on all medical and physical therapy consultations throughout the duration of the Games. Main outcome measurements Number of patients treated during the 2010 Vancouver Paralympic Winter Games, stratifi ed by accreditation status, injury or illness type and services consulted. Results At the Vancouver 2010 Paralympic Winter Games, more than 2717 medical interventions occurred for injury or illness, of whom 25% were athlete encounters (n=657). Consultations were mainly for minor injury/illness, majority of musculoskeletal nature; with only seven hospitalisations (fi ve athletes) for a total of 24 inpatient days stay (16 days for athletes). 977 pharmacy prescriptions were issued, which in seven cases were followed up with a Therapeutic Use Exemption application. Alpine Ski was responsible for over 50% of the athlete imaging visits and approximately 20% of total imaging visits (n=332). Physical therapy interventions (n=897) primarily addressed back and shoulder structures. Conclusion A critical analysis of the actual fi ndings and an effi cient transfer of knowledge indicate the need for a multidisciplinary approach with other functional areas related to the organisation of Paralympic (Winter) Games, as well as for the initiating of longitudinal study to gain further and in-depth knowledge on sport injuries and exercise-induced physiological reactions in Paralympic Athletes.